Developing policies that will eliminate barriers to the adoption of telehealth technology, such as expanding broadband services and providing resources to help implement the technology, will enable more American Indians and Alaska Natives (AI/ANs) to access healthcare in a cost effective and efficient way, according to Howard Hays, acting chief information officer for the Indian Health Service (IHS).

Hays, who recently testified before the Senate Committee on Indian Affairs, said, "The distribution of the American Indian and Alaska Native populations and our healthcare facilities over some of the most beautiful but isolated and underserved parts of the country increases the challenges of healthcare delivery, especially where specialty care and consultation are concerned. This is where the telehealth services can have their greatest impact."

With the rate of heart disease, diabetes, and certain mental health disorders considerably higher among AI/ANs, compared with other racial/ethnic groups, Hays noted that patients have limited access to specialists at local hospitals, but said that telehealth closes the long distance gap between patients and specialists through the use of videoconferencing technology and electronic devices to exchange medical information over Internet networks.

The Alaska Federal Health Care Access Network (AFHCAN) program provides telehealth services to more than 300 Alaska villages and federal sites. More than 106,000 telehealth cases have been created in AFHCAN over the last decade, and through the use of store and forward technology, AFHCAN has reduced waiting times for specialty care and dramatically reduced patient's travel costs.

Hays also pointed to the IHS Joslin Vision Network (JVN) tele-ophthalmology program, which serves 78 sites in 22 states. More than 50,000 patient examinations have been conducted through the JVN program, including 10,000 patients who received their first eye exams last year. Through Internet networks, JVN sends retinal photographs to a central reading center where specialists access the pictures; that enables them to diagnose early diabetic retinopathy and recommend interventions to reduce the risk of blindness.

"Howard Hays' comments add to a growing body of success stories for telehealth bringing care to rural and underserved population," Irene Berlinsky, IDC's senior research analyst for multiplay services told InformationWeek Healthcare. "Telehealth has dramatically improved the lives of American Indian and Alaska Natives, but as is often the case with telehealth, the benefits are clear but implementation is murkier."

Hays also said that, "Few of these services are available system-wide and substantial variation exists across Indian Health regarding the availability of telehealth tools and the infrastructure to support using them. ... Network infrastructure in many locations is insufficient and requires upgrading, operational capacity for expanded implementation of training and technical support is often sub-optimal, and many programs lack the clinical and support staff to coordinate and perform the services. Finally, reimbursement policies for telehealth services lag behind the available technologies [and impedes] Indian Health facilities to promote adoption and change."

Jonathan Linkous, CEO of the American Telemedicine Association, told InformationWeek Healthcare that many of the same barriers to telehealth adoption that Hays described are also facing the adoption of telehealth/telemedicine elsewhere.

Furthermore, when telehealth is not adopted, it has a negative impact on jobs, limits the potential to raise the quality of healthcare, and makes the delivery of care more expensive.

"Economic development is linked to so many elements of healthcare: cost, availability, and quality. Telemedicine addresses all three of these points. With the spiraling costs of healthcare and the growing number of elderly and those with chronic conditions, telemedicine is an absolute requirement in helping to solve this crisis," Linkous said.

It is sobering to think about how easy access is for some parts of the world and is just NOT in other parts. Especially, when those that would benefit from telehealth, not just based on region, but on chronic conditions of the underserved, are extremely limited to access.

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